Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Kronik İnmeli Hastalarda Transkraniyal Doğru Akım Stimülasyon Tedavisinin Üst Ekstremite Motor Fonksiyonları Üzerine Olan Etkisi: Prospektif Randomize Kontrollü Bir Çalışma
The Effect of Transcranial Direct Current Stimulation Therapy on Upper Extremity Motor Functions in Patients with Chronic Stroke: A Prospective Randomized Controlled Study
Elif ÖZCANa, Tuğba GÖKBELb, Çiğdem ÇEKMECEc, Nigar DURSUNb
aKocaeli Üniversitesi Sağlık Bilimleri Enstitüsü, İş ve Uğraşı Terapi Bölümü, Kocaeli, Türkiye
bKocaeli Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon ABD, Kocaeli, Türkiye
cKocaeli Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Terapi ve Rehabilitasyon Bölümü, Kocaeli, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(2):101-10
doi: 10.5336/medsci.2021-87662
Article Language: TR
Full Text
ÖZET
 Amaç: Bu prospektif, randomize kontrollü çalışmanın amacı, kronik inmeli hastalarda anodal transkraniyal doğru akım stimülasyon (TDAS) tedavisinin, plejik üst ekstremite motor fonksiyonları üzerine olan etkinliğini değerlendirmektir. Gereç ve Yöntemler: Üst ekstremite spastisitesine yönelik olarak botulinum toksin A (BoNT-A) tedavisi uygulanmış 20 kronik inmeli hasta, TDAS (n=10) ve kontrol (n=10) grupları olmak üzere 1:1 oranında randomize edildi. Her iki grup toplam 10 seans iş ve uğraşı terapi (İUT) programına alındı. TDAS grubuna, İUT ile eş zamanlı olarak anodal TDAS tedavisi uygulandı. Plejik üst ekstremite motor fonksiyonları Jebsen-Taylor El Fonksiyon Testi (JTEFT), Kutu Blok Testi (KBT) ve Modifiye Frenchay Skala'sı (MFS) ile değerlendirildi. Bulgular: Her iki grupta demografik özellikler ve tedavi öncesi tüm klinik değerlendirmeler benzer bulundu (p>0,05, tüm parametreler için). Tedavi sonrasında TDAS grubunda JTEFT ve MFS'nin tüm alt parametrelerinde (tüm parametreler için p<0,01), ve KBT'de (p<0,01) istatistiksel olarak anlamlı gelişmeler elde edildi. Kontrol grubunda ise KBT (p=0,011), JTEFT'nin 3 ve MFS'nin 7 parametresinde (anlamlı parametreler için p<0,05) anlamlılık saptandı. Tedavi sonrası TDAS grubunun KBT (p<0,001), MFS tüm alt parametre (tüm parametreler için p<0,05) sonuçlarındaki gelişmeler kontrol grubununkilerden anlamlı derecede yüksekti. Ayrıca tedavi sonrasında JTEFT'nin beslenme (p=0,011), geniş hafif objeleri kavrama (p=0,003) ve geniş ağır objeleri kavrama (p=0,049) sürelerindeki kısalma TDAS grubunda kontrol grubuna oranla anlamlı derecede daha iyiydi. Sonuç: Bu çalışmada, BoNT-A uygulamasını takiben İUT ile kombine edilen anodal TDAS tedavisinin, kronik inmeli hastaların plejik üst ekstremite motor fonksiyonları üzerine ilave yararlar sağladığı gösterilmiştir.

Anahtar Kelimeler: İnme; iş ve uğraşı terapisi; transkraniyal doğru akım stimülasyonu; üst ekstremite
ABSTRACT
 Objective: The aim of this prospective, randomized, controlled study was to evaluate the effectiveness of anodal transcranial direct current stimulation (TDCS) applications on the upper extremity motor functions of patients with stroke. Material and Methods: Twenty patients with chronic stroke who received botulinum toksin A (BoNT-A) treatment for upper limb spasticity were randomly assigned in a 1:1 ratio into two groups as anodal TDCS (n=10), or control (n=10). Both groups participated in an occupational therapy (OT) program for 10 days. Simultaneous anodal TDCS treatment with OT was applied to the TDCS group. The plegic upper extremity motor functions were evaluated by Jebsen-Taylor Hand Function Test (JTHFT), Box and Block Test (BBT) and Modified Frenchay Scale (MFS). Results: Demographic characteristics and baseline clinical assessments were found to be similar in both groups (p>0.05 for all parameters). After the treatment, statistically significant improvements were obtained in all sub-parameters of JTHFT, and MFS (p<0.01 for all parameters) and BBT (p<0.01) in the TDCS group. Whereas in the control group significance was present in BBT (p=0.011), 3 parameters of JTEFT, and 7 of MFS (p<0.05 for these parameters). The magnitude of improvement in BBT (p<0.001), and in all parameters of MFS of the TDCS group (p<0.05, all of the parameters) were significantly higher than those of the control group after treatment. Besides decrease in the time spent for feding (p=0.011), lifting large light objects (p=0.003) and large heavy objects (p=0.049) of the TDCS group was significantly better than those of the control group. Conclusion: In this study, TDCS combined with OT programs following the BoNT-A injection was shown to provide additional benefits on motor functions of the plegic upper extremity of chronic stroke patients.

Keywords: Stroke; occupational therapy; transcranial direct current stimulation; upper extremity
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